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Sunday, February 22, 2015
Zofran is the brand name for a drug whose generic name is Ondansetron. It is a prescription drug often used for severe nausea and vomiting as often seen in viral illnesses of the stomach or "stomach flu". It may also be used in conjunction with cancer chemotherapies which can produce severe nausea and vomiting.
It is occasionally used to treat hyperemesis gravidarum or the severe abnormal exaggerated upper gastrointestinal response to the hormones of pregnancy. It is not indicated in the treatment of normal nausea and vomiting in pregnancy. There are some occasional other uses particularly in the field of addiction and withdrawal. The drug is available as an injectable and also in an orally disintegrating tablet.
In general, this is a good drug. It can help to prevent the admission of a patient to a hospital for overnight intravenous hydration by quelling the cyclic severe nausea and vomiting of certain viral illnesses. It can help to advance the settling of one's stomach sufficient to allow some fluids taken by mouth and this is a largely positive thing. It can help to make chemotherapy more tolerable for a patient who requires it. It can allow the patient to complete a recommended course rather than to electively abbreviate or terminate it.
However, there are a subgroup of people who need to be particularly careful prior to using this drug. Ondansetron is noted to have the capacity to lengthen the QT portion of an otherwise normal EKG. In a susceptible subgroup of patients, this can lead to arrhythmia and potential for sudden death. Certainly anyone who experiences a rapid heartbeat or any noted change in heartbeat while taking Ondansetron should return to the hospital emergency room.
As the parent of a child who died of a sudden arrhythmic disorder which had been unknown to his doctors and to us, why would I mention it ? Daniel did not use Ondansetron prior to his sudden passing. However, this may be of issue to those of you who have lost a child or family member and who have other children or family members who may have the same proclivity to arrhythmia, which may be as yet undiagnosed. Two of Daniel's brothers have in fact, used Ondansetron for a day or so following a stomach flu on two separate years. We did use the drug knowing that arrhythmia was a potential side effect, but the emergency room physicians ordering the drug made the decision that the benefits outweighed the risks at that particular juncturet of the treatment. Both young adults were well enough to be able to discontinue the drug after the initial 24 hours of use.
My reason for letting all of you know about Ondansetron is that even among the population of those who have lost a sibling to a sudden arrhythmic disorder that there can be an appropriate short term use for the drug. You should also know that a sibling of someone who has died of presumed Long QT Syndrome should not receive this drug in the longer term.
Make sure that any physician ordering drugs for your family or your children know that you have lost a family member to Long QT Syndrome, if in fact, you have.
As always, just as my thoughts and memories are always with Daniel, my thoughts are also with the other parents and families who suddenly and inexplicably lost a healthy child to a sudden arrhythmic death of which there is most often, no warning.
Tuesday, February 10, 2015
Yesterday afternoon I was working with the horses and the alpacas. I was moving alfalfa, sweeping out stalls, rinsing out water buckets as I listened to the radio I tend to keep on in the day for the animals. Only one station stays on playing calm music and interviews all through the duration of the day. It's not my favorite station but it goes a long way to keeping animals calm especially when there is bad weather which is amplified by the tin roof. Yesterday as I swept I listened to the story of a young boy who had a serious cancer at age ten. His mother had moved Heaven and Earth in order to get him into some experimental studies. From the interview he was a precious boy and for a moment I understood his mother's quest to do almost anything to keep her son alive. As I listened, swept, mopped and distributed a coat of thin pine shavings to a shiny stall floor, I was hopeful. Certainly such a promising drug regimen would work on children as well as adults. I expected to hear good news, and so I slowed my work for a moment to listen. I was unprepared for the news that the boy, Joey, had not responded to the drug and had died the day before Thanksgiving. All at once I recalled that Daniel had departed from us the day after Thanksgiving. The feeling sat there in my abdomen as if I had been gently kicked by a short horse ! I was especially saddened to hear the interviewer ask the mother if she had regretted continuing treatment when the doctors had given them the option to go home to die and to see his friends. She had decided to stay the course waiting for her miracle, and this time, it had not paid off. At first she said she thought she made the right decision, and then even within the same sentence, she changed her mind. This is a doubt I think she will have all of her life. Sadly, when we lose a child every choice we ever made will be periodically second guessed. Why did I not take Daniel to a cardiac electrophysiologist at twelve ? Because I had no idea he would develop a cardiac electrophysiological issue. Why did I not let him stay out later a couple of days before his passing ? It would have been unlikely to have made any difference, and he would have enjoyed it. Why did I not divert money from other things we did here, and take Daniel to Europe ? Because, at that particular juncture of his life, he would rather have stayed here on the farm with his siblings, his animals, and his computer ! Parents who have lost children will always second guess the choices we made with them I suppose this comes with the territory. There is something we can do though. When we hear of someone who has lost a child, we can support them in the choices they made. We only have limited information when we make some of the choices for our children. We don't have a crystal ball. We don't know all that will happen in their future lives or in our own. We need to work to understand and accept that we made the best choices for our children with all of the information we had at the time. We would have done nothing less for our beloved children. My prayer yesterday is for Joey's family and particularly his mother. May she come to know that she did everything she could for him in a difficult situation, and that he knew that. This is what I wish for all of you who come to Daniel's blog for some crumb of wisdom.
This is a link which would allow you also to listen to the story of Joey Xu